Smoking Bans Reduce Secondhand Exposure, MIs

Action Points

Explain to interested patients that bans on smoking in public appear to reduce secondhand smoke exposures and heart attacks.

Note that smoking bans do not appear to reduce smoking in homes and cars.

People are exposed to less secondhand smoke and suffer fewer heart attacks in countries and states that restrict smoking in public, a research review has concluded.

Studies have consistently found that smoking bans reduce secondhand smoke exposure in workplaces, restaurants, bars, and other public places, with hospitality workers experiencing the greatest reduction in exposure, according to the review published online in the The Cochrane Library.

Research also suggests that hospital admissions for heart attacks drop in regions with public smoking bans, and that some health indicators improve in these areas as well.

"Workers, particularly in the hospitality sector, have benefited from reduced exposure to passive smoke and attributable health benefits associated with cardiac care particularly are suggestive of a benefit," Cecily Kelleher, MD, of University College Dublin in Ireland, and colleagues wrote.

"The balance of evidence suggests that legislative smoking bans have achieved their primary objective of reducing exposure to secondhand smoke."

Tobacco is the second leading cause of mortality, accounting for about one in ten adult deaths worldwide, according to the World Health Organization.

Since the late 1980s, the number of public smoking bans and restrictions has increased, theoretically reducing smoking and exposure to secondhand smoke, but the long-term effect of bans and restrictions remains an open question.

To sum up previous research, Kelleher and colleagues reviewed studies of the impact of bans on public smoking from a range of databases, including the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, EMBASE, PsycINFO, CINAHL and Conference Paper Index.

They included studies that explicitly studied smoking bans and had a minimum of six months follow-up for measures of smoking behaviors.

While the authors found that bans reduced secondhand smoking exposure in a range of public spaces, areas that were more private appeared unaffected. They failed to detect any difference in exposure to secondhand smoke in cars or homes as a result of legislative bans.

The authors cautioned that research they examined lacked randomized controlled studies that focused on a smoking ban as an intervention, and that the predominant method of evaluating the bans were uncontrolled studies with a before-and-after design. These were often unable to control for possible confounders and changes in secular trends over time.

"Nonetheless, the balance of evidence from both the repeated cross-sectional and cohort studies strongly suggests that the primary objective of reducing tobacco smoke exposure was achieved, particularly amongst hospitality workers," they wrote. "This was validated in many studies by cotinine measures and corroborated in some cases also by improvements in air quality."

The authors reported no outside sources of funding or financial conflicts of interest.

MedPageToday is a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.

Physicians and other healthcare professionals may also receive Continuing Medical Education (CME) and Continuing Education (CE) credits at no cost for participating in MedPage Today-hosted educational activities.